The second round of the Dutch colorectal cancer screening program: Impact of an increased fecal immunochemical test cut-off level on yield of screening.

Arthur I Kooyker,Harry J De Koning,Ernst J Kuipers,Hanneke J Van Vuuren,Manon C.W Spaander,Esther Toes‐Zoutendijk,Maarten G.J Thomeer,Iris D Nagtegaal,Monique E Van Leerdam,Folkert J Van Kemenade,Annemieke W.J Opstal‐Van Winden,Chris Ramakers,Maaike Buskermolen,Iris Lansdorp‐Vogelaar,Evelien Dekker

doi:10.1002/ijc.32839

Abstract

The Dutch colorectal cancer (CRC) screening program started in 2014, inviting the target population biennially to perform a fecal immunochemical test (FIT). We obtained prospectively collected data from the national screening information‐system to present the results of the second round (2016) and evaluate the impact of increasing the FIT cut‐off halfway through the first round from 15 to 47 μg Hb/g feces on outcomes in the second round. Second round screening was done with a 47 μg Hb/g feces FIT cut‐off. Participants were classified based on first round participation status as either FIT (15,47) or FIT (47,47) participants, and previous nonparticipants. In total, 348,891 (75.9%) out of 459,740 invitees participated in the second round. Participation rates were 93.4% among previous participants and 21.0% among previous non‐participants. FIT(47,47) participants had a significantly higher detection rate of AN (15.3 vs. 10.4 per 1,000 participants) compared to FIT(15,47) participants in the second round, while their cumulative detection rate of AN over two rounds was significantly lower (45.6 vs. 52.6 per 1,000 participants). Our results showed that participation in the Dutch CRC screening program was consistently high and that second round detection rates depended on the first round FIT cut‐off. The cumulative detection over two rounds was higher among FIT(15,47) participants. These findings suggest that a substantial part of, but not all the missed findings in the first round due to the increased FIT cut‐off were detected in the subsequent round.

Highlights

Many countries have recently introduced colorectal cancer (CRC) screening with the aim to reduce CRC incidence and mortality
Our results showed that participation in the Dutch CRC screening program was consistently high and that second round detection rates depended on the first round fecal immunochemical testing (FIT) cut-off
Out of the FIT-positive participants, 14,102 (90.4%, 95% confidence intervals (95% CI): 90.0–90.9%) individuals attended the pre-colonoscopy intake, of which 13,163 (93.3%, 95% CI: 92.9–93.7%) were advised to undergo colonoscopy

Summary

Introduction

Many countries have recently introduced colorectal cancer (CRC) screening with the aim to reduce CRC incidence and mortality. These programs use different screening strategies.[1] Colonoscopy is the gold standard for detecting advanced neoplasia (AN) because of its high sensitivity. Colonoscopy is an invasive procedure that demands extensive resources when used for primary screening on a population level. Many countries prefer a non-invasive fecal test for primary screening, followed by colonoscopy when tested positive.

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Results

Conclusion